study of perfusion and anatomy's role in coronary artery (cad)

Conditions: Known CAD, or Intermediate-high Pretest Likelihood for CAD

Summary: three main clinical outcomes will be assessed: 1. post-test resource utilization as assessed by referral rate to catheterization within 90-days of the index study; 2. incremental prognostic value and risk stratification for predicting cardiac death and myocardial infarction; 3. cost-effectiveness to this end, sparc is organized with two distinct specific objectives with important differences in patient population and endpoints. specific aim 1: to evaluate the impact of stress perfusion imaging with spect or pet, ct angiography, and hybrid pet-ct on post-test resource utilization. the primary endpoint of specific aim 1 is to compare the impact of combined myocardial perfusion-coronary anatomy data to that of perfusion only \[stress spect, stress cardiac pet (without cta)\] and anatomy only (cta alone) on post-test resource utilization, as measured by referral to cardiac catheterization within 90 days of index noninvasive testing, in patients without cad. secondary endpoints: 1. to compare the diagnostic accuracy for detection of epicardial cad of stress pet and hybrid pet-ct, stress spect, and cta, as defined by coronary angiography; 2. to compare the referral rate to revascularization within 90 days of cardiac catheterization. specific aim 2: to compare the incremental prognostic value and risk stratification of stress perfusion imaging with spect or pet, ct coronary angiography, and combined perfusion-anatomy imaging approaches. the primary endpoint of specific aim 2 is to compare the incremental value of stress perfusion only (stress pet and stress spect), coronary anatomy only (cta data), and combined perfusion-anatomy studies (pet+cta and spect+cta) over clinical, historical and stress test data for the prediction of cardiac death and nonfatal myocardial infarction. secondary endpoints: 1. to compare the incremental value of these noninvasive imaging approaches over clinical, historical and stress test data for the prediction of a composite endpoint including cardiac death, nonfatal myocardial infarction, late (\>6 month from index study) referral to revascularization, or late (\>6 month from index study) hospitalization for chest pain or heart failure; 2. to compare the incremental value of these noninvasive imaging approaches over clinical, historical and stress test data for the prediction of all cause mortality. in addition, the ability of these modalities -together and separately- to risk stratify patients is a primary goal of specific aim 2.


Eligibility criteria:
inclusion criteria: * referred for a clinical stress spect, stress pet, cta or pet-ct study * intermediate to high pretest likelihood for cad (\>.25;as defined by acc/aha stable angina guidelines) without prior mi/pci/cabg. these are considered diagnostic patients. or * documented known cad as defined by prior mi/pci/cabg * provide signed informed consent to participate in the study exclusion criteria: * low pretest likelihood for cad (\<=.25; as defined by acc/aha stable angina guidelines). * major concomitant noncardiac disease or social condition/situation that in the opinion of the investigator will preclude the patient from participation in the study follow-up. * concurrent or prior(within last 30 days) participation in other research studies using investigational drugs or devices. * presence of a permanent automated internal cardiac defibrillator (aicd) * known non-ischemic cardiomyopathy * chest pain at rest within 48 hours prior to the index noninvasive imaging test

Keywords: coronary anatomy coronary artery disease spect pet pet/ct cta